2862 Severity of EGJOO and Correlation to Elevations in IRP

Abstract

INTRODUCTION: Esophagogastric Junction Outflow Obstruction (EGJOO) is an abnormality of the lower esophageal sphincter (LES) which is associated with an elevation of the Integrated Relaxation Pressure (IRP). EGJOO is part of a group of disorders associated with impaired relaxation of the LES, however it remains separate from Achalasia (types I-III) due to retained peristalsis. Delayed bolus transit is frequently impaired in EGJOO due to this collection of abnormalities within the esophagus. Our goal with this retrospective analysis was to determine if there existed a correlation between an elevated IRP and solid/viscous bolus transit in patients with EGJOO. METHODS: We performed a retrospective analysis of patients who were diagnosed with EGJOO by high resolution manometry from 2015 to 2018 at a single tertiary care center. Patients were classified as having EGJOO by the Chicago Classification (version 3). An IRP of 20 or above was the cutoff in this analysis. This analysis collected a sample size of 100 patients whose manometry studies were consistent with EGJOO. RESULTS: A linear regression analysis was performed on the 100 patients reviewed. There was a weakly negative correlation between bolus transit time and an elevation in IRP. However, overall, IRP increase did not have a statistically significant impact on liquid/viscous bolus transit. CONCLUSION: In summary, an elevated integrated residual pressure (IRP) coupled with preserved esophageal body peristalsis is required for diagnosis of EGJOO. Our data revealed no statistically significant correlation between an elevated IRP and an increase in liquid/viscous bolus transit time. As such, an increase in IRP may not indicate severity of EGJOO. Therefore, success of endoscopic intervention may not be accurately indicated by observation of IRP by HRM. More data is needed to better correlate endoscopic intervention with IRP values.